Irving Independent School District v. Tatro

In Irving Independent School District v. Tatro (1984), the U.S. Supreme Court addressed the question of whether the related services provision of the Education of the Handicapped Act of 1975, now known as the Individuals with Disabilities Education Act (IDEA), required a school board in Texas to provide clean intermittent catheterization during class hours to a student who could not voluntarily empty her bladder because of her spina bifida. In holding that the board was required to provide catheterization, the Court reasoned that because this service was required in order for the child to remain at school during the day and that it was a simple procedure that could be performed in a few minutes by a lay person with less than an hour’s training, it qualified for coverage under the IDEA.

Tatro stands out as the Supreme Court’s first attempt to define the distinction between school supportive health services, which officials must provide under the IDEA as related services identified in students’ Individualized Education Programs if they are necessary to assist children with disabilities to benefit from special education, and medical services, which they are not required to supply unless they are for diagnostic or evaluative purposes.

In resolving Tatro, the Supreme Court relied on the U.S. Department of Education’s regulations to define the disputed terms. Pursuant to these regulations, school health services are those that can be provided by school nurses or other qualified lay persons. On the other hand, medical services are those that must be performed by licensed physicians. Insofar as clean intermittent catheterization did not have to be carried out by a physician, but could be performed by a school nurse or trained lay person, and because it would have allowed the child to remain at school during the day, the Court was satisfied that it qualified as a related service under IDEA. As such, the Court determined that school officials had to provide this service for the child.

Tatro also included general guidelines outlining the scope of a school board’s responsibility for providing IDEA-related services to students. First, the Supreme Court reiterated that eligible children must be identified as having disabilities in order to receive special education services. Second, the Court acknowledged that school officials are required to supply only those services that are necessary to aid children to benefit from special education, regardless of how easily school nurses or lay persons could furnish the needed services. Third, the Court noted that school nursing services must be provided only if they can be performed by nurses or other qualified lay persons, not if they must be performed by physicians. In addressing this final point, the Court specified that it was reasonable to assume that the IDEA was designed to spare school boards from the responsibility of supplying medical services such as those performed by doctors that might have proved unduly expensive and beyond the range of educators’ competence.

Courts most often cite Tatro in addressing questions of what qualifies as related services under the IDEA. The result is that courts frequently reach different results in applying Tatro. For example, two years after Tatro, a federal trial court in New York denied services to a child whose severe physical disabilities required constant nursing care (Detsel v. Board of Education of Auburn Enlarged City School District, 1986). Yet, 13 years later, the Supreme Court, in Cedar Rapids Community School District v. Garret F. (1999) decided that a child who was paralyzed from the neck down and required continuous one-on-one nursing services qualified for that care under the related services provision of IDEA. In Garrett F., the Court recognized the importance of the distinction it explained in Tatro, namely that excluded medical services refer only to those that must be performed by physicians, not to those that can be provided by school health services, such as nursing care that can be delivered by a school nurse or trained lay persons.